영아 내사시의 임상양상과 수술결과

정은지,장윤희,장지호,한승한,이종복,Eun-Jee Chung,Yoon-Hee Chang,Ji-Ho Chang,Seung-Han Han,Jong-Bok Lee 대한안과학회 2005 대한안과학회지 Vol.46 No.5

Purpose: To study the clinical manifestations and surgical outcome of infantile esotropia. Methods: This review retrospectively examined 165 patients of infantile esotropia who had undergone recession of bilateral medial rectus muscles from April 1991 to September 2001 at our institute. We measured the binocular alignment and analyzed the long term surgical outcome. Results: The average angle of deviation of 165 patients was 45.9±13.99PD (25~90PD) and the average refractive error was +sph 1.18±2.25D (-sph 7.00~+sph 6.00D). Amblyopia was found in 48.4% of the patients, DVD in 12.7%, IOOA in 11.3%, and manifest latent nystagmus in 6.0%. A binocular alignment within 10 PD was achieved in 73.9% and 57.9% at the 2nd and 4th post-operative year respectively. Conclusions: The surgical outcome of bimedial rectus muscle recession in infantile esotropia was satisfactory in 74%, and 58% of the patients at the 2nd and 4th post-operative year respectively.

병적 근시와 동반된 맥락막 신생혈관에서 광역학 치료의 임상 적용

정은지,오현섭,고형준,이성철,권오웅.Eun-Jee Chung. M.D.. Hyun-Sub Oh. M.D.. Hyoung-Jun Koh. M.D.. Sung-Chul Lee. M.D.. Oh-Woong Kwon. M.D. 대한안과학회 2005 대한안과학회지 Vol.46 No.4

Purpose: To evaluate the effects of photodynamic therapy with verteporfin on visual acuity and fluorescein angiography in choroidal neovascularization (CNV) associated with pathologic myopia and to determine if this treatment could reproduce the results achieved in the Verteporfin in Photodynamic Therapy (VIP) Trial in Korean patients. Methods: Forty-two eyes of 39 patients with CNV secondary to pathologic myopia were included. A retrospective review of their clinical records and fluorescein angiography was done. The patients underwent photodynamic therapy with verteporfin and were followed up for more than 6 months after the therapy. The change in best corrected visual acuity (BCVA) and leakage in fluorescein angiography were evaluated. Results: The mean age of the patients was 39.6 and mean follow-up period was 23.5 months. The BCVA of the patients improved in 22 (52.4%) eyes, was unchanged in 13 (30.9%), and worsened in 7 (16.7%). The leakage in fluorescein angiography decreased in 25 (59.5%) eyes. Conclusions: Photodynamic therapy with verteporfin for myopic CNV in Korean patients appeared to be effective in stabilization of the lesions and improvement of visual acuity.

증식성당뇨망막병증에서 유리체절제술과 백내장병합수술 후 굴절력 예측

한승수(Seung Soo Han),정은지(Eun Jee Chung) 대한안과학회 2015 대한안과학회지 Vol.56 No.5

목적: 증식성당뇨망막병증 환자에서 유리체절제술과 백내장병합수술 전 목표 굴절력과 수술 후 실제 굴절력 사이에 어떤 차이가 있는지 분석하고, 굴절력에 영향을 미치는 요소에 대해 알아보고자 한다. 대상과 방법: 유리체절제술과 수정체초음파유화술 및 인공수정체삽입술을 동시에 시행한 환자 39명 44안을 대상으로 후향적 조사를 하였다. 술 전 A-scan 및 IOL Master를 이용하여 안구 길이 및 안구생체계측을 시행하고, 술 후 굴절력을 측정하여 목표 굴절력과 실제 굴절력을 비교하였으며 평균예측이상값과 평균절대예측이상값을 계산하였다. 또한 굴절력에 영향을 미치는 환자의 전신상태, 수술 과정 전, 후 인자들에 대하여 통계학적으로 분석하였다. 결과: 전체 44안의 A-scan 기준 술 후 3개월 평균예측이상값은 -0.23 ± 0.52 디옵터, 6개월의 평균예측이상값은 -0.23 ± 0.47 디옵터로 3개월 사이에는 유의한 변화가 없었다(p=0.959). 술 후 3개월의 평균절대예측이상값은 0.45 ± 0.35 디옵터, 6개월에서 0.40 ± 0.33 디옵터로 3개월 사이에 유의한 변화는 보이지 않았다(p=0.196). 두 가지 검사가 모두 가능하였던 20안에서 술 후 3, 6개월 평균예측이상값은 모두 A-scan을 기준으로 한 결과가 유의하게 작은 굴절이상값을 갖는 것을 확인할 수 있었다(p=0.002, 0.002). 술 전 당뇨병성신증 병발, 술 후 발생한 신생혈관녹내장이 부정확한 평균예측이상값 및 평균절대예측이상값과 유의한 연관성을 보였다. 결론: 증식성 당뇨망막병증에서 유리체절제술과 백내장병합수술은 허용할 만한 수준의 작은 굴절력 오차 범위 내의 결과를 보였다. 당뇨병성신증, 신생혈관 녹내장을 동반한 경우에서 술 후 부정확한 굴절력을 보이며, 기대하는 굴절력을 더 정확히 얻기 위해 광학적 생체계측과 초음파 모두를 사용하는 것이 바람직하겠다. <대한안과학회지 2015;56(5):737-744> Purpose: To evaluate the accuracy of intraocular lens (IOL) power estimation and the factors associated with outcome in eyes undergoing combined phacovitrectomy for proliferative diabetic retinopathy. Methods: We performed a retrospective case review of 39 consecutive patients (44 eyes) that underwent phacovitrectomy for proliferative diabetic retinopathy. Axial lengths were measured using ultrasound (A-scan) and/or optical biometry (IOL Master). Achieved and predicted refractions were compared to calculate the mean postoperative refractive prediction error (ME) and the mean absolute prediction error (MAE). Systemic conditions of patients and several preoperative and postoperative factors re-lated to the postoperative refraction were analyzed. Results: The ME of 44 eyes were −0.23 ± 0.52 diopters (D) and -0.23 ± 0.47 D after 3 and 6 months, respectively (range, -1.40~+0.79 D). There was no statistically significant difference in the refractive outcomes between the refractive errors (p = 0.959). The MAEs were 0.45 ± 0.35 D and 0.40 ± 0.33 D after 3 and 6 months, respectively with no statistical significant differ-ence between the results (p = 0.196). When comparing ME in the 20 eyes that achieved both results, ultrasound was more accu-rate than optical biometry (p = 0.002, 0.002). The factors associated with more inaccurate ME and MAE after phacovitrectomy were diabetic nephropathy and neovascular glaucoma. Conclusions: Combined phacovitrectomy in proliferative diabetic retinopathy showed small biometric errors within the tolerable range in most cases. Patients with neovascular glaucoma and diabetic nephropathy had more inaccurate postoperative re-fractive power. Both optical biometry and ultrasound should be used to estimate axial lengths for improving the accuracy of IOL power calculation. J Korean Ophthalmol Soc 2015;56(5):737-744

횡경막상부에 국한된 임상적 병기 1-2기 호지킨병에서 치료 결과와 예후 인자의 분석

박원(Won Park),서창옥(Chang Ok Suh),정은지(Eun Ji Chung),조재호(Jae Ho Cho),정현철(Hyun Cheol Chung),김주항(Joo Hang Kim),노재경(Jae Kyung Roh),한지숙(Jee Sook Hahn),김귀언(Gwi Eon Kim) 대한방사선종양학회 1998 Radiation Oncology Journal Vol.16 No.2

목 적 : 시험개복술을 시행하지 않은 임상적 병기 1기, 2기 횡경막상부 호지킨병에서 후향적으로 치료 결과를 분석함으로써 시험개복술의 필요성을 재검토하였고 예후 인자를 분석하고, 예후 인자군의 유용성을 평가하고자 하였다. 대상 및 방법 : 1985년에서 1995년까지 연세의료원에서 횡경막 상부에 국한된 임상적 병기 1-2기 호지킨병으로 진단받고 치료를 받았던 51례를 대상으로 하였다. 연령은 4-67세까지 였으며 중앙값은 30세였고 병기별로는 ⅠA, ⅡA, ⅡB가 각각 16례, 25례, 10례였다. 방사선치료는 4, 6 MV 광자선으로 매일 1.5-1.8Gy씩 19.5Gy에서 55.6Gy(중앙값 : 45Gy)가 조사되었으며, 항암화학요법은 방사선치료 전후에 2-12회(중앙값 : 6회) 시행되었다. 방사선치료 단독, 항암화학방사선 병용요법, 항암화학요법 단독이 각 각 31례, 16례, 4례에 시행되었고 방사선치료는 involved field 방사선치료가 3례, 맨틀방사선치료가 26례, 부분적림프절방사선치료가 18례에서 시행되었다. 생존율 분석은 Kaplan-Meier method, 유의성 검증은 log-rank test를 이용하였다. 결 과 : 5년 전체 생존율은 87.6%, 무병 생존율은 78.0%였다. 완전 관해된 50례 중 림프절만 재발한 경우가 4례, 간이나 폐 또는 비장에서 재발한 경우가 3례, 림프절과 간에 동시에 재발된 경우가 1례 있었다. 재발한 8례중 구제 치료가 항암화학요법 단독, 방사선치료 단독, 항암화학방사선병용요법이 각 각 4례, 1례, 2례에서 시행되어 이중 2례만 구제되었다. 여성이거나 거대 종격동 림프선비대가 있는 경우에 재발이 의미있게 많았고 전체 생존율은 B 증상이 있거나 임상적 병기가 높을수록 의미있게 낮았다. EORTC 예후 인자군에 따른 5년 무병 생존율은 very favorable군(VF군), favorable군(F군), unfavorable군(U군)이 각각 100, 100, 55.8%, 5년 전체 생존율은 100, 100, 75.1%로 통계적으로 의미있는 차이를 보여주었다. VF군과 F군은 방사선치료만으로도 100%의 생존율을 보였으나 U군에서는 항암화학방사선병용요법시 방사선치료 단독보다 적은 재발율을 보였으나 생존율은 비슷하였다. 방사선치료를 받았던 경우에 맨틀방사선치료보다 부분적 림프절방사선치료를 받은 경우에 무병 생존율이 높았다. 결 론 : 횡경막상부에 국한된 호지킨병에서 시험개복술을 시행하지 않고도 좋은 치료 결과를 보여주었다. 성별, 거대 종격동 림프선비대가 무병 생존율에 의미있는 영향을 주었고 B 증상, 임상적병기는 전체 생존율에 영향을 주는 중요한 예후 인자였다. 그리고 EORTC 예후 인자군에 따른분류가 예후 예측과 치료 방법을 결정하는데 유용함을 확인할 수 있었다. Purpose : The aim of this retrospective study is to assess the necessity of staging laparotomy in the management of supradiaphragmatic CS Ⅰ- Ⅱ Hodgkin's disease. Prognostic factors and the usefulness of prognostic factor groups were also analyzed. Materials and Methods : From 1985 to 1995, fifty one patients who were diagnosed as supradiaphragmatic CS Ⅰ- Ⅱ Hodgkin's disease at Yonsei Cancer Center in Seoul, Korea were enrolled in this study. Age range was 4 to 67 with median age of 30. The number of patients with each CS ⅠA, ⅡA, and ⅡB were 16, 25, and 10, respectively. Radiotherapy(RT) was delivered using 4 or 6 MV photon beam to a total dose of 19.5 to 55.6Gy (median dose : 45Gy) with a 1.5 to 1.8Gy per fraction. Chemotherapy(CT) was given in 2-12 cycles(median : 6 cycles). Thirty one patients were treated with RT alone, 4 patients with CT alone and 16 patients with combined chemoradiotherapy. RT volumes varied from involved fields(3), subtotal nodal fields(18) or mantle fields(26). Results : Five-year disease-free survival rate(DFS) was 78.0% and overall survival rate(OS) was 87.6%. Fifty patients achieved a complete remission after initial t reatment and 8 patients were relapsed. Salvage therapy was given to 7 patients, 1 with RT alone, 4 with CT alone, 2 with RT + CT. Only two patients were successfully salvaged. Feminine gender and large mediastinal adenopathy were significant adverse prognost ic factors in the univariate analysis for DFS. The significant adverse prognostic factors of OS were B symptom and clinical stage. When patients were analyzed according to European Organization for Research and Treatment of Cancer(EORTC) prog-nostic factor groups, the DFS in patients with very favorable, favorable and unfavorable group was 100, 100 and 55.8%(p<0.05), and the OS in each patients' group was 100, 100 and 75.1%(p<0.05), respectively. In very favorable and favorable groups, the DFS and OS were all 100% by RT alone, but in unfavorable group, RT with CT had a lesser relapse rate than RT alone. The subtotal nodal irradiation had better DFS than mantle RT in patients treated with RT. Conclusion : In present study, the DFS and OS in patients who did not undergo staging laparotomy were similar with the results in the literatures of which patients were surgically staged. Therefore, we may suggest that staging laparotomy would not influence the outcome of treatments. In univariate analysis, gender, large mediastinal adenopathy, B symptoms and clinical stage were significant prognostic factors for the survival rate. We confirm the usefulness of EORTC prognostic factor groups which may be a good indicator to select the treatment modality.

백내장수술 후 발생한 급성 안내염의 발생률과 위험인자 분석

이승재(Seung Jae Lee),김지원(Jiwon Kim),홍정화(Jung Hwa Hong),정은지(Eun Jee Chung) 대한검안학회 2020 Annals of optometry and contact lens Vol.19 No.4

Purpose: To evaluate the incidence and risk factors of acute postoperative endophthalmitis (POE) after cataract surgery from 2011 to 2015 in Korea. Methods: A nationwide retrospective cohort study was performed by using claims data from the Korean National Health Insurance Service (KNHIS) database collected during 2011 to 2015. Cataract surgery and acute POE were identified using Korean Electronic Data Interchange (KEDI) code and Korean Classification of Disease (KCD)-7 code. Results: A total of 2,236,107 eyes in 1,591,176 patients (60.16% female; mean age 69.37 ± 10.07 years) underwent cataract surgery from 2011 to 2015 in Korea. The incidence of acute POE after cataract surgery was 0.09% and remained stable during 5 years period as the unadjusted incidence rate ratio (IRR) was 1.025 (95% confidence interval 0.988-1.064; p = 0.1932). A total of 2,041 eyes experienced acute POE (51.23% female; mean age 67.84 ± 11.99 years) after 8.46 ± 10.18 days after the cataract surgery. In multivariate analysis, intraoperative posterior capsule rupture, male gender and preoperative diabetes were associated with a higher risk of acute POE: 5.643 (4.454-7.148, p < 0.001), 1.408 (1.283-1.544, p < 0.001), 1.241 (1.125-1.371, p = 0.0167), respectively. Living in rural area, low household income and surgery in tertiary healthcare centers were socioeconomic factors significantly associated with higher risk of acute POE. Conclusions: The incidence of acute POE after cataract surgery in Korea remained unchanged during 5-year study period. Intraoperative posterior capsule rupture, male, preoperative diabetes, low household income and surgery in tertiary healthcare centers were associated with higher risk.

한국인 망막 열공 환자에서 초광각 안저촬영술의 진단적 유용성

안현민(Hyun Min Ahn),임형택(Tyler Hyung Taek Rim),정은지(Eun Jee Chung) 대한안과학회 2016 대한안과학회지 Vol.57 No.8

목적: 망막 열공 환자에서 산동 후 안저검사와 초광각 안저촬영술을 비교함으로써 초광각 안저촬영술의 유용성을 알아보고자 하였다. 대상과 방법: 망막 전문의에 의해 산동 후 안저검사에서 망막 열공 소견을 확인한 이후, 초광각 안저촬영술을 시행한 160명의 환자(230개의 병변)의 의무기록을 후향적으로 환자 특징 및 병변의 위치에 따라 분석하였다. 병변의 위치는 적도부 기준으로 전후 망막으로, 그리고 전후 망막을 각각 4개 구역(상측, 하측, 이측, 비측)으로 나누어 초광각 안저촬영술의 민감도와 특이도를 구하였다. 결과: 초광각 안저촬영술 민감도는 72% (95% 신뢰구간[95% confidence interval {CI}] 65-79%), 특이도는 94% (95% CI 90-98%)였다. 앞뒤 망막으로 비교를 하였을 때, 뒤쪽 망막의 경우, 민감도는 89% (95% CI 85-93%)였으며, 앞쪽 망막의 경우, 민감도는 72%(95% CI 66-78%)였으며, 앞뒤 망막에서 초광각 안저촬영술의 민감도는 통계학적으로 유의한 차이가 있었다(p=0.007). 부위별로 민감도를 비교하였을 때, 상, 이, 비측 부위별 민감도에서는 앞뒤 망막의 차이가 없었으나, 하측 민감도의 경우 앞뒤 망막의 민감도 차이가 있었으며, 앞쪽 망막의 하측 민감도는 43% (95% CI 29-57%)였다. 결론: 한국인 망막 열공 검사에 있어서 초광각 안저촬영술은 전체적으로 양호한 민감도를 보였으나 앞쪽 하측의 민감도는 상대적으로 낮은 것을 확인할 수 있었다. 따라서 초광각 안저 촬영술은 산동 후 안저 검사에 보조 장비로 사용할 수 있으나, 병변의 위치에 따라 민감도가 유의한 차이를 보이므로 산동 후 안저검사가 병행되어야 할 것으로 사료된다. Purpose: To evaluate the availability of ultra-wide-field fundus photography compared to fundus examination after pupil dilatation in Korean patients with retinal break. Methods: For this retrospective case review of consecutive 160 patients, 230 lesions with retinal breaks were recruited. The ultra- wide-field images were taken after fundus examination with pupil dilatation performed by a retinal specialist. We analyzed ultra- wide-field images according to patient characteristics and separated area. We divided lesions into anterior and posterior areas, and each area was separated into 4 quadrants (superior, inferior, temporal, and nasal). Results: The sensitivity of ultra-wide-field imaging for detecting retinal break was 72% (95% confidence interval [CI] 65-79%), and the specificity was 94% (95% CI 90-98%). The sensitivity of detection of posterior retina was 89% (95% CI 85-93%), and that of anterior retina was 72% (95% CI 66-78%); this difference was significant (p = 0.007). There was a significant statistical difference at the inferior quadrant between anterior and posterior retina, but not at superior, temporal, or nasal quadrants. The sensitivity of detection in the inferior quadrant in the anterior retina was 43% (95% CI 29-57%). Conclusions: Ultra-wide-field fundus photography can detect retinal break, but there is limitation in anterior retinal lesions, especially the inferior area. Therefore, ultra-wide-field fundus photography cannot be an alternative method instead of fundus examination with pupil dilatation.

시각장애인에서 장애 등록 시점 전후 만성 및 외상질환 발생 변화에 관한 연구

성효진(Hyo Jin Seong),김지원(Jiwon Kim),육태미(Tae Mi Youk),김현기(Hyunki Kim),정은지(Eun Jee Chung) 대한안과학회 2021 대한안과학회지 Vol.62 No.8

목적: 만성 대사질환과 외상질환의 시각장애 등록 전후 발생 변화를 분석해보고자 한다. 대상과 방법: 2005년부터 2013년까지 시각장애인으로 등록된 환자들과 연령, 성별, 보험료 분위수, 거주 지역 분포에 대하여 1:1 성향점수매칭을 통해 선정한 대조군에서 질병 발생 비율과 위험도를 비교하였다. 국민건강보험공단 자료를 이용하였으며, 관찰 기간은 시각장애 등록 시점을 기준으로 2년 전부터 5년 후까지로 정하였다. 관심 시점에서 질환의 발생 비율(%)은 장애 등록 연도별 발생 비율의 평균으로 구하였고, 위험도는 조건부 로지스틱 회귀분석을 이용해 측정하였다. 결과: 총 131,434명의 시각장애 환자군과 동일한 수의 대조군이 포함되었다. 만성 대사질환과 낙상 관련 부상의 발생 비율은 장애 등록 이전에는 시각장애인에서 더 높았으나, 장애 등록 이후에는 점차 감소하여 대조군과 유사하게 변화하였다. 또한 장애 등록 후 2년까지 시각장애인에서 만성 질환의 발생 위험이 더 높았던 반면, 낙상 관련 부상의 발생 위험은 시각장애인에서 관찰 기간 동안 지속적으로 높았다. 고관절 골절은 시각장애인에서 장애 등록 이전 약 1년 전부터 점차 증가하여 대조군에 비해 발생 비율과 위험이 지속적으로 높았다. 결론: 시각장애인은 비장애인보다 만성 질환의 발생 빈도가 높고, 고관절 골절이나 낙상 등 외상질환에 노출될 위험이 크다. 시각장애인 환자들뿐만 아니라 장애 등록 예정인 환자들에서 각종 질환들의 발생을 예방하고 조기에 치료할 수 있도록 지역사회 인프라를 확충하고, 복지 서비스를 확대 실시해야 할 것이다. Purpose: To analyze changes in the incidences of chronic and traumatic diseases before and after registration as visually disabled. Methods: The incidence and risk of chronic and traumatic diseases were compared between patients registered as visually disabled from 2005 to 2013 and a control group, selected through 1:1 propensity score matching for age, sex, premium quantile, and residential area distribution. Data from the National Health Insurance Service were used and the observation period was set from 2 years before to 5 years after the time of registration as visually disabled. The incidences (%) of chronic and traumatic diseases at the point of interest were determined as the mean values according to year of registration, and the risk was measured by conditional logistic regression analysis. Results: 131,434 visually disabled patients and the same number of non-visually impaired controls were included. The incidences of chronic disease and fall-related injury were higher in the visually disabled group before registration, but gradually decreased and became similar to the control group after registration. In addition, the risk of developing chronic diseases was higher in the visually disabled group until 2 years after registration, while the risk of fall-related injury remained consistently higher in the visually disabled group during the observation period. The incidence and risk of hip fracture in the visually disabled group increased gradually from approximately 1 year before registration and remained consistently higher than in the control group. Conclusions: People with visual disability have higher incidences of chronic diseases than do non-visually impaired people and are at greater risk of traumatic injuries, such as hip fractures or falls. There is a need to establish community infrastructure and expand welfare services for the prevention and early treatment of comorbidities, both for patients with registered visual disabilities and for patients who have not yet registered.